氟芬太尼、氢吗啡酮和氯胺酮给药后舍曲林治疗患者出现术后紧张症：病例报告。
Postoperative Catatonia After Fentanyl, Hydromorphone, and Ketamine Administration in a Patient Taking Sertraline: A Case Report.
机构信息
From the Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts.
出版信息
A A Pract. 2023 Jul 18;17(7):e01695. doi: 10.1213/XAA.0000000000001695. eCollection 2023 Jul 1.
Opioid-induced catatonia is underrecognized and poorly understood in the literature. An 81-year-old woman with chronic kidney disease stage III taking sertraline underwent surgery with general anesthesia, receiving fentanyl, hydromorphone, and ketamine. Postoperatively, she was unresponsive, rigid, and cataleptic with pinpoint pupils. Symptoms resolved with a naloxone infusion suggesting opioid-induced catatonia as the leading diagnosis. Differential diagnoses and etiologies discussed reveal a possible multifactorial catatonia mechanism involving opioids, ketamine, and serotonin. Anesthesiologists should consider these potential interactions when using opioids for management of vulnerable patients.
阿片类药物引起的紧张症在文献中认识不足且了解甚少。一位 81 岁患有慢性肾脏病 III 期的女性正在接受舍曲林治疗，她接受了全身麻醉下的手术，使用了芬太尼、氢吗啡酮和氯胺酮。术后，她出现无反应、僵硬和木僵状态，瞳孔针尖大小。纳洛酮输注后症状缓解，提示阿片类药物引起的紧张症为主要诊断。讨论的鉴别诊断和病因表明，可能涉及阿片类药物、氯胺酮和 5-羟色胺的多因素紧张症机制。当使用阿片类药物管理脆弱患者时，麻醉师应考虑这些潜在的相互作用。
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